Bipolar Disorder and Polysubstance Use Disorder: Sociodemographic and Clinical Correlates

Andrea Aguglia; Antimo Natale; Laura Fusar-Poli; Andrea Amerio; Edoardo Bruno; Valeria Placenti; Eleonora Vai; Alessandra Costanza; Gianluca Serafini; Eugenio Aguglia; Mario Amore

doi:10.3389/fpsyt.2022.913965

Bipolar Disorder and Polysubstance Use Disorder: Sociodemographic and Clinical Correlates

Front Psychiatry. 2022 Jun 15:13:913965. doi: 10.3389/fpsyt.2022.913965. eCollection 2022.

Authors

Andrea Aguglia^{1

2}, Antimo Natale³, Laura Fusar-Poli³, Andrea Amerio^{1

2}, Edoardo Bruno^{1

2}, Valeria Placenti^{1

2}, Eleonora Vai^{1

2}, Alessandra Costanza^{4

5}, Gianluca Serafini^{1

2}, Eugenio Aguglia³, Mario Amore^{1

2}

Affiliations

¹ Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.
² Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genoa, Italy.
³ Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
⁴ Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland.
⁵ Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland.

Abstract

Introduction: Patients with bipolar disorder (BD) often show comorbidity with substance use disorder (SUD) with a negative impact on clinical course, prognosis, and functioning. The role of polysubstance use disorder (polySUD) is understudied. The aim of the present paper is to evaluate the sociodemographic and clinical characteristics associated with BD and comorbid SUD, focusing on polySUD, in order to phenotype this specific group of patients and implement adequate treatment and prevention strategies.

Methods: A cross-sectional study was conducted involving 556 patients with a primary diagnosis of BD (376 without SUD, 101 with SUD, and 79 with polySUD). A semi-structured interview was administered to collect sociodemographic variables, clinical characteristics, and pharmacological treatment. ANOVA and chi-square tests were used to compare the three groups. Significantly different variables were then inserted in multivariate logistic regression.

Results: Patients affected by BD and polySUD were younger, and more frequently males and single, than patients with SUD or without SUD. Indeed, the prevalence of patients affected by BD and polySUD living in residential facilities was higher than in the other groups. Moreover, earlier age at onset, higher prevalence of psychotic and residual symptoms, involuntary hospitalization, and a family history of psychiatric disorders were associated with polySUD in patients suffering from BD. Lastly, patients with BD and polySUD were more likely to take four or more medications, particularly benzodiazepines and other drugs. At the multinomial regression, younger age, male gender, early age at onset, psychotic and residual symptoms, positive family history of psychiatric disorders, and use of benzodiazepines remained significantly associated with polySUD in patients with BD.

Conclusion: Our findings show a specific profile of patients with BD and polySUD. It is important to conduct research on this topic in order to adopt specific therapeutic strategies, minimize the use of polypharmacy, and aim at full remission and mood stabilization.

Keywords: bipolar disorder; polypharmacy; psychotic symptoms; substance use disorder; treatment.